DIC的治疗.ppt

DIC的诊断与治疗
北京协和医院血液科
王书杰
DIC的定义
Disseminated Intravascular Coagulation
DIC是一种发生于多种疾病或特殊病理状态下,人体凝血系统被激活而引起中小血管内弥漫性微血栓形成及继发性纤溶亢进的综合征。
由于DIC发展过程中出现不同程度的血小板和凝血因子水平消耗性减少,也称之为“消耗性凝血病”或“消耗性血栓出血性疾病”。
Clinical conditions associated with DIC
1. Sepsis/Severe infection --- -------- %
2. Malignancy ------------------------- %
Solid tumors %,AL %. Occurrence in APL 37~65%.
3. Obstetrical calamities ------------ %
Amniotic fluid embolism, Abruptio placentae, Dead fetus
4. Trauma / Surgery ----------------- %
5. Severe hepatic failure ------------ %
6. Vascular abnormalities
Kasabach-Merritt syndrome,Large vascular aneurysms
7. Organ destruction (., severe pancreatitis)
8. Severe toxic or immunologic reactions
Snake bites,Recreational drugs,Transfusion reactions,Transplant rejection
Mortality
DIC----Death ing.
Mortality ranges from 31~86%, whether or not heparin was administrated.
Correlated Factors:
Underlying disorders
The extent on dysfuction
The degree of hemostatic failure
Increasing age
The Simplified Mechanism of DIC
DIC的失调控
Sepsis、Cancer、Trauma、plications: TF 
Liver Disease: AT-III、PC/PS 
Sepsis: TM、PC 
Pregnancy: PS 
APL、Amniotic Fluid Embolism、Prostate Cancer: Plasmin 
IXa
(+VIII)
Xa
(+V)
TF+VIIa
Thrombin
Fibrinogen
Fibrin
Decrease of AT-III
Impairment of
PC System
Insufficient TFPI
Cytokines
(IL-6, etc.)
Plasminogen
Plasmin
Fibrin
FDPs
PA
PAI-1
Generation of Thrombin
Mediated by TF
Impairment of
Anticoagulation
Pathway
Suppression of
Fibrinolysis
by PAI-1
Formation of Fibrin
Inadequate Removal of Fibrin
Thrombosis of Small and Midsize Vessels
ic Pathways Involved in DIC
Abnormal Coagulation in DIC